Tuesday, June 29, 2010

I'm about half way through my current block of night shifts and I'm learning that night shifts are definitely not something I want to do on a long term basis.

For five nights a week, I work just under 14 hours. This leaves me with 10 hours to commute, sleep, shower, and complete any required daily activities. The lack of free time isn't really a concern right now--it's more of the sleeping schedules. Once my shift ends, I mentally shut down. All I can think about is getting a couple hours of sleep. Unfortunately, it's made driving home a little difficult. I've started listening and singing show tunes as I drive home in the morning so I'm more alert. I'm not going to lie--it's been a little scary some mornings.

Along with the sleeping, my meal schedules stink. I feel like my body has mostly adjusted to staying up all night and sleeping during the day, but there are still some moments where I find myself eating to stay awake. Not good.

Exercise has also taken a major back burner. Unfortunately, my knee pain has been pretty bad. I know a large part of it is I've dropped off doing my prescribed knee exercises and tried other work outs. Last week I didn't work out at all though. Now just with nights, but residency in general, I have to make time for work outs and my knee exercises. I know I prescribe physical therapy to my patients, and I know it's beneficial, but it definitely can be annoying when it's needed for such a long term basis. I'm almost at the point where I feel like I'm never going to not have to do my knee exercises.

Now here's the major kicker--I hardly get to see my husband! Joe's started training for a new job and our schedules will not cross paths until Friday night :( So, for those who work nights on a regular basis so people like me don't have to, thank you!

My rating: 4 of 5 starsI really enjoyed this book. I've heard wonderful things about Kostova's previous book, The Historian, but I haven't had a chance to read it yet. Hopefully I can pick it up soon.

The Swan Thieves revolves around a middle-aged male admitted to a psychiatric hospital. Kostova uses the perspective of 3 characters to help tell Robert's story. I really enjoyed hearing the story from three different perspectives. Kostova did a wonderful job giving each character its own distinguishable personality. Learning about Robert from three different people helped give him depth that I think only could be accomplished from multiple perspectives.

I have very limited experience with inpatient psychiatry, but I still believe Kostova did a wonderful job exploring his mental illness and how it affected his family and friends.

One of the main characters is Robert's wife. I do feel Kostova left her story slightly unresolved, but I can easily get over it.

Overall, I definitely recommend this book!

I listened to the unabridged audio version and it was wonderful! I cannot commend the narration enough.

Wednesday, June 23, 2010

...went remarkably well. As a med student, I had a white cloud over me and, at least for last night, it's carried over. I only had to complete two admissions, so that gave me plenty of time to get to know the patients and the computer system.

Some people mention it's a little difficult transitioning from introducing yourself as the med student to the doctor, but oddly, it almost seemed like second nature. I introduced myself primarily as Dr. Amanda, so it was less formal, but still let the parents know I was the doctor taking care of their child. The white coat, however, I can't stand. Firstly, I ordered my white coat entirely too big. For my short white coat from med school, I ordered a tall and once I had loaded my pockets, it was just a little too tight to button, but the sleeves were perfect. With that in mind, I ordered the next size up and a tall again for my long white coat. Oh my goodness, I'm floating in it! I truly feel like I'm wearing a cape as I walk down the halls. It's so big, the sleeves are too long, and I feel like it's a little unprofessional. I can pay for a new one, so after I try on some of my fellow classmates, I'm ordering another. In general, I'm not a fan of the white coat. Sometimes I feel the white coats scream, "look at me, I'm a doctor." I don't need everyone in the hospital knowing I'm a doctor, just my patients and the nurses helping the team care for our patient. So why don't I stop wearing my white coat? Simple--I need the pockets. Right now I still need to carry around a fair number of crib sheets, patient information, etc. One day I'll be able to ditch the white coat.

Other than dealing with my cape of a white coat, the most difficult part of last night was determining how much autonomy I have. As a med student, I had to run every decision past my supervising resident. So last night when a patient asked to disconnect her child from continuous oxygen monitoring so she could carry her around the unit and I saw no reason to keep her on continuous oxygen monitoring clinically, I didn't know if I had the authority to change it on my own. Yes, I felt a little crazy running that order by my supervising resident when I didn't see any clinical reason for continuous oxygen monitoring, but I still did. I never did any rotations at this hospital before and haven't met the attendings, so I really don't have a good feel for what I can and can't do yet. It'll come with time. With kids' lives in my hands, I'd rather run a menial order past my supervising resident than cause harm. It's still odd that I can actually write orders and they mean something. It's also humbling that I feel comfortable answering some of the nurses questions confidently on my first night--I guess I did learn more than I thought in med school.

So, if you made it this far, thanks for reading and I'm off to be a doctor again tonight =)

Tuesday, June 22, 2010

We haven't had any children yet, but having a child definitely can change a couple's priorities and lifestyle. However, I personally believe every couple should take some time to themselves and remember what it's like to be husband and wife, and not just mom and dad. To do that, you often need to hire a babysitter. Here are some reminders from the Academy of Pediatrics found on HealthyChildren.org.

The following list of information should always be left with a babysitter:

* Meet the sitter and check references and training in advance. * Be certain the sitter has had first aid training and knows CPR. * Be sure the babysitter is at least 13 years old and mature enough to handle common emergencies. * Have the sitter spend time with you before babysitting to meet the children and learn their routines. * Show the sitter around the house. Point out fire escape routes and potential problem areas. Instruct the sitter to leave the house right away in case of fire and to call the fire department from a neighbor's house. * Discuss feeding, bathing, and sleeping arrangements for your children. * Tell your sitter of any allergies or specific needs your children have. * Have emergency supplies available including a flashlight, first aid chart, and first aid supplies. * Tell the sitter where you will be and when you will return. * Be sure any guns are stored unloaded in locked cabinet.

Sitters Should:

* Be prepared for an emergency. * Always phone for help if there are any problems or questions. * Never open the door to strangers. * Never leave the children alone in the house - even for a minute. * Never give the children any medicine or food unless instructed to do so by the parents. * Remember that their job is to care for the children. * Tender loving care usually quiets an unhappy child.

Tonight I officially start my residency. I'm on nights, so I'll be responsible for doing the admissions and answering any questions that come up overnight. I'm not really a night person and I've been trying to shift my sleep schedule the past couple of days, but was unsuccessful. I have about 6 hours before I need to leave our apartment, so I'm going to try to take a nap for a little bit.

I'm both nervous and excited. There's a senior resident working with me, so I'm not completely on my own, but this is the first time I'll be actually responsible. If I feel like a kid needs tylenol for the fever, I can actually order it--I don't have to ask someone else. I know I have more emotions running through me right now, but I don't really know how to express them. Nothing bad or stressful, but just kind of in awe that I'm actually here. I had a dream, I stuck to it, and now I'm seeing it come into fruition.

My rating: 4 of 5 starsI finally finished this book! It hasn't taken me over three weeks to read a book in ages. I guess that's what I get with starting residency and being close to family and friends again--I don't have as much dead time to kill. Either way, I really enjoyed this book. I think the second in the series was the best, but this did a nice job of tying up loose ends.

Saturday, June 19, 2010

I had some leftover pumpkin after making the pumpkin scones. The recipe is actually for muffins, but I wanted to make a cake I could bring as a dessert to a picnic. The cake turned out, but I definitely think it would cook better as muffins. Overall, very delicious and moist! I'd add a little more nutmeg (or I need to buy a new thing of nutmeg since mine is over two years old).

Recipe adapted from Food Network In general, I often substitute some of the white flour with white whole wheat flour. I don't know if it does anything, but at least it makes me think the recipe is just a tad bit healthier.

In a medium bowl, whisk together the all-purpose and whole-wheat flours, baking soda, salt, cinnamon, ginger, cloves, and nutmeg.

In a large bowl, whisk the sugar, molasses, oil and 1 egg until combined. Add the other egg and whisk well. Whisk in the pumpkin and vanilla. Whisk in the flour mixture in 2 batches, alternating with the buttermilk. Whisk just until combined.

Pour the batter into the prepared muffin pan and sprinkle with the pumpkin seeds. Tap the pan on the counter a few times to remove any air bubbles. Bake for 20 minutes or until a wooden pick inserted in center of 1 of the muffins comes out clean.

Let cool on a wire rack for 15 minutes. Run a knife around the muffins to loosen them and unmold. Cool completely on the rack.

Thursday, June 17, 2010

I am amazed at how much some kids swear these days. While the American Academy of Pediatrics says it's a developmental transition, I still think kids swear more now than when I was a kid--but that could be because more parents swear in front of their kids nowadays too. Either way, here's what the American Academy of Pediatrics has to say to help deal.

Swearing–the use of profanity or "dirty'' words–is almost a developmentally normal behavior for children during middle childhood and early adolescence. For these youngsters, swearing is often a sign of being worldly-wise and unafraid to be a little "bad." Profanity is used to impress friends and can become a part of peer relationships. Quite frequently, younger children do not know the meanings of the words they are using, but they will say them anyway simply because they have heard others use them.

Fortunately, this phenomenon of cursing seems to lose its attraction and abate as children become more mature. Until then, however, youngsters often delight in shocking their parents with the swear words they have learned away from home. (Bear in mind that parents who swear in the home are teaching their children to do the same and should not be surprised when their youngsters copy their behavior.)

Clearly, there is a smaller group of "incorrigible" children who swear. In addition to cursing, they have many other difficulties, personally and socially. These youngsters may be more prone to swear and rage at other people–a different phenomenon than using a few swear words during times of frustration. Profanity directed at another individual should never be tolerated.

What Parents Can Do

Here are some suggestions to help you manage the problem of swearing:

* If you feel it is appropriate, establish a rule that "no swearing will take place in our home." Do not under any circumstances tolerate swearing that is aimed at someone in anger. If this occurs, a child may be sent immediately to her room for a timeout. * Minor swearing in frustration is almost a natural human behavior. Although perhaps inappropriate, it is commonplace in some families. If that is your own personal style, you will find it hard to teach your child something different. * When your youngster swears, do not overreact with your own outbursts of rage and cursing. Also, washing a child's mouth out with soap is clearly improper, extreme and ineffective. * On occasion, you may feel that your child is using profanity in an attempt to provoke a response from you. In these instances, ignoring her may be the most effective strategy. * Reward your child for expressing her frustration appropriately without swearing. Star charts and money are helpful approaches. For example, use a jar of nickels that she can earn at the end of two weeks; for each day that she doesn't swear during this time, two additional nickels will be placed in the jar; but each time she swears, nickels will be removed. Your child will catch on quickly.

When To Seek Additional Help

In and of itself, swearing is not a sign of emotional disturbance. However, if there are other problems–chronic lying, chronic stealing, or difficulty with peers–than swearing may be just another symptom of a psychological or social disturbance. In this situation, talk to your pediatrician about counseling - either individual or family therapy.

Sunday, June 13, 2010

At our Omaha home, I had a bag of peanut butter chips I really didn't want to move out--well I didn't want them to melt during the move. The solution? Peanut butter cookies! I haven't made peanut cookies for, well I can't even remember the last time. I usually just use the recipe from Jif, but since I have Baking Illustrated, I figured I'd give the recipe a try. My grandmother couldn't get enough of them! Yes, they were that good. The recipe calls for peanuts, but as much as I love peanut butter, I'm really not a fan of peanuts, so that's when I used the peanut butter chips.

1. Preheat oven to 350 degrees. Line two baking sheets with parchment paper or spray with nonstick cooking spray.2. Whisk flour, baking soda, baking powder, and salt together in medium bowl; set aside.3. Beat butter until creamy. Add the sugars; beat until fluffy. Beat in peanut butter until fully incorporated. Beat in eggs one at a time. Add the vanilla. Gently stir in the dry ingredients. Add the peanut butter chips (or peanuts) until just incorporated.4. Roll approximately 2 tablespoons of dough into a ball. Place balls on prepared cookie sheet, spacing 2/5 inches apart. Press each ball with a fork, dipping fork into cold water as needed to prevent dough from sticking.5. Bake until cookies are puffed and slightly brown around the edges, about 10-12 minutes, rotating the cookie sheet half way through. Cool cookies until set (about 4 minutes) and transfer to wire rack to finish cooling.6. Enjoy!

Saturday, June 12, 2010

Yesterday I was fortunate enough to have off from orientation and I knew I wanted to get my hair cut. It's nice that it's getting longer, but it's so darn hot and takes so long to do! Having just moved to the area, I needed to find a hair stylist. While searching for one, I found that there is a hair school just around the corner from me. Being a resident physician and knowing what it's like to be in a learning position, I talked myself into giving the hair school a try. Plus, it only costs $9 for a hair cut. Yeah, umm...I think my girl was afraid to cut hair off. I asked for about an inch off and long layers. I walked out with an inch off, but almost everything was the same length. I hated it. If it was the winter, it would have been fine, but it was still too thick and almost looked like a bell.

So then I drive around to find a salon with an opening...and I found a my new hairdresser =) I told the lady I just went to the hair school to get it cut and liked the length, but needed some more layers. She told me she'd just double check to make sure the back was straight. Yeah, it wasn't.

Now I don't want to dis going to the hair school, because we all have to learn, I just happened to get someone who was a little timid and still needed some practice. In the mean time, I ended up finding a new person. I just laugh that I got two hair cuts on the same day.

Sorry, no picture for this one. This is primarily a white based bread with whole grains. The next time I make it, I think I'll substitute more whole wheat flour for the white flour, or even eliminate the white flour. I really enjoyed the texture of this bread. Enjoy!

*Use this amount in the summer. In winter, you'll probably only need to use 3 cups of flour.

Manual Method: In a large mixing bowl, pour the boiling water over the bulgur, and let the mixture sit till it's lukewarm, about 15 minutes. Add the seeds, oats, salt, eggs, oil, honey, sugar, yeast, and enough flour to make a soft dough. Knead the dough on a lightly oiled surface until it's smooth, then place it in a lightly greased bowl, cover the bowl, and allow the dough to rise for 1 to 1 1/2 hours, or until it's doubled in bulk.

Remove the dough from the bowl, shape it into a loaf, and place it in a lightly greased 8 1/2 x 4 1/2-inch bread pan. Cover the pan with lightly greased plastic wrap, and set the loaf aside to rise till it's crowned about 1 inch over the rim of the pan, 45 minutes to 1 hour.

Bake the bread in a preheated 350°F oven for 35 minutes or until it tests done, draping it lightly with aluminum foil, shiny side up, after 20 minutes if it appears to be getting too brown. Remove the pan from the oven, and turn the loaf out onto a wire rack to cool completely. Yield: 1 loaf.

Bread Machine Method: In the pan of your bread machine, pour the boiling water over the bulgur, and let the mixture sit till it's lukewarm, about 15 minutes. Add the remaining ingredients, place the pan in the machine, program the machine for Manual or Dough, and press Start. When the machine has completed its cycle, remove the dough, and shape and bake it as directed above. Yield: 1 loaf.

I baked the bread in my machine as well, just adjusted my baking time to 37 minutes.

Place all of the ingredients except the cinnamon bites and raisins into the pan of your machine as directed by manufacturer, program for raisin or mixed bread, and press Start. Add the bites and raisins at the signal. (If your machine doesn't have an "add-in" cycle, program it for basic or white bread, and add the chips about 5 minutes before the end of the final kneading cycle.) Yield: 1 loaf.

ENJOY!

And if you're wondering what's up with my mediocre photos recently, I've been crunched with time, so it might be the point and shoot more often and less staging--we'll see.

Tuesday, June 8, 2010

I know it's not quite pumpkin season yet, but hey, with canned pumpkin, it's always pumpkin season! I used some of my graduation money to buy a scone pan and I knew I had to try it out. Most of the scones I've tasted are fairly dense. These scones, however, are almost like cake. Overall, I enjoyed them, as did my friends.

In a separate small bowl, stir together pumpkin puree, buttermilk and vanilla. Pour into flour mixture just until it forms a soft dough. Be careful not to overmix.

Omitted since I used a scone pan: Turn dough out onto a lightly foured surface and knead gently, just three or four times. Pat dough into a circle about 1-1/2 inches thick. Cut into 8 equal wedges (like slices of pie).

Where in the heck have I been? Starting residency! Orientation started yesterday and between that and making our apartment a home, I've had little time. Hopefully I'll be able to keep up with this blog, but probably not as frequently. We'll see.

Now onto the post. It's summer time and the pools are open. Water can be an excellent source of summer fun, but let's not forget how dangerous it is too. The jury is still out as to when to start swimming lessons, but definitely not before the age of one. No matter the age, even if your child has had swimming lesson, water safety is essential. Here are some tips from the American Academy of Pediatrics.

____________________________________________________

If you do enroll a child under four years old in a swimming program, be sure the class you choose adheres to guidelines established by the national YMCA. Among other things, these guidelines forbid submersion of young children and encourage parents to participate in all activities. But remember that even a child who knows how to swim needs to be watched constantly. Whenever your child is near water, follow these safety rules:

1. Be aware of small bodies of water your child might encounter, such as bathtubs, fishponds, ditches, fountains, rain barrels, watering cans—even the bucket you use when you wash the car. Empty containers of water when you’re done using them. Children are drawn to places and things like these and need constant supervision to be sure they don’t fall in.

2. Children who are swimming—even in a shallow toddler’s pool—always should be watched by an adult, preferably one who knows CPR. The adult should be within arm’s length, providing “touch supervision” whenever infants, toddlers, or young children are in or around water. Empty and put away inflatable pools after each play session.

3. Enforce safety rules: No running near the pool and no pushing others underwater.

4. Don’t allow your child to use inflatable toys or mattresses in place of a life jacket. These toys may deflate suddenly, or your child may slip off them into water that is too deep for him.

5. Be sure the deep and shallow ends of any pool your child swims in are clearly marked. Never allow your child to dive into the shallow end.

6. Backyard swimming pools, (including large, inflatable above-ground pools), should be completely surrounded with at least a 4-foot (1.2 meters) high fence that completely separates the pool from the house. The fence should have a self-closing and self-latching gate that opens away from the pool, with the latch at least 54 inches high. Check the gate frequently to be sure it is in good working order. Keep the gate closed and locked at all times. Be sure your child cannot manipulate the lock or climb the fence. No opening under the fence or between uprights should be more than 4 inches (10 cm) wide. Keep toys out of the pool area when not in use so that children are not tempted to try to get through the fence.

7. If your pool has a cover, remove it completely before swimming. Also, never allow your child to walk on the pool cover; water may have accumulated on it, making it as dangerous as the pool itself. Your child also could fall through and become trapped underneath. Do not use a pool cover in place of a four-sided fence because it is not likely to be used appropriately and consistently.

8. Keep a safety ring with a rope beside the pool at all times. If possible, have a phone in the pool area with emergency numbers clearly marked.

9. Spas and hot tubs are dangerous for young children, who can easily drown or become overheated in them. Don’t allow young children to use these facilities.

10. Your child should always wear a life jacket when he swims or rides in a boat. A life jacket fits properly if you can’t lift it off over your child’s head after he’s been fastened into it. For the child under age five, particularly the non swimmer, it also should have a flotation collar to keep the head upright and the face out of the water.

11. Adults should not drink alcohol when they are swimming. It presents a danger for them as well as for any children they might be supervising.

12. Be sure to eliminate distractions while children are in the water. Talking on the phone, working on the computer, and other tasks need to wait until children are out of the water.

Friday, June 4, 2010

If you haven't picked up yet, I have a husband who's pretty picky when it comes to food. He's getting better on trying new things, but I have to pick my recipes carefully if I expect him to at least give it a try. Since he loved the beef brisket I made over the winter, I figured I'd try a new recipe.

This one was definitely more sweet than the previous one, almost a little too sweet for me even. I may have added too much brown sugar, I can't remember. Either way, this particular brisket reminded me of shredded pork barbecue and was great on a roll. Joe didn't necessarily like the sweetness though. I made it just before Dad came to help move us out. He definitely had no problem finishing it off.

Recipe adapted from Smitten Kitchen who adapted it from Emeril. I halved the recipe, which is reflected here.

Prepare the sauce: Heat a large skillet over medium high heat and sauté onions in vegetable oil, stirring occasionally, until caramelized and most of liquid has evaporated, about 15 minutes. Add minced garlic cloves and saute for 3 minutes more. Stir in spices and seasoning (paprika, salt, garlic and onion powders, black pepper, cayenne, oregano and thyme) and cook for 2 minutes. Set aside.

In a large bowl, stir together the beef stock, ketchup, chili sauce and brown sugar. Don’t worry if your brown sugar is lumpy (mine always is), the acidity of the ingredients will quickly break it down.

While my husband eats onion rings, he doesn't eat sauted onions (who knows). So, once I made the sauce, I used my Ninja (love that thing!) to puree everything. (Yes, I'm trying to hide the vegetables and it worked!)

If baking in oven: Preheat oven to 350 degrees. Place brisket in a baking dish or casserole, spread onion mixture over the top, then pour sauce mixture over the entire dish. Cover tightly with foil bake until very tender but not falling apart, about 3 to 4 hours.

If making in a slow cooker (which I did): Place brisket in a slow cooker and pour pureed mix over it. Cover with the lid and place in fridge over night. In the morning, cook on low for 8-10 hours. Smitten Kitchen has lots of other directions, which I omitted. At this point, I just let it cool slightly and then sliced and enjoyed.

I'm learning I'm becoming action dependent with my editing. As soon as I open a photo, I look through my actions to determine which I want to use. I think part of is trying to be creative. When I edit my own photos, I'm constantly using CoffeeShop's Perfect Portrait, and Pioneer Woman's define and sharpen, but rarely the more dramatic actions. I think I see these Fix It Fridays as a opportunity to use more of the dramatic ones. Or perhaps, like everything, I'm just over analyzing things.

Here's the original. Personally, I think it looks pretty darn good just straight from the camera.Comparing the two, they look pretty darn similar. First, I let Elements decide on my auto levels. Then, I'm finding I really like using Pioneer Woman's Lovely action on babies. After running the lovely action, I used PW's Sharpen This action to bring out the footprint. Needless to say, I didn't really do anything dramatic with this photo.

Ok, I had to play a little, so here it's with Coffee Shop's Sepia action.

Thursday, June 3, 2010

I made these cupcakes for my med school class's White Coat Burning picnic. Unfortunately, I didn't get a chance to taste them, but they got rave reviews. I did taste the filling, and it definitely tasted like delicious cookie dough! These are labor intensive and I'm glad I spaced the baking out over two days. I had a fair amount of leftover filling and icing, so I used it to make a cookie dough dip (future post).

I've been trying to weigh my ingredients more than using measuring cups. I've included my weights here.

To make the cupcakes, preheat the oven to 350° F. Line two cupcake pans with paper liners (24 total). In the bowl of a stand mixer fitted with the paddle attachment, combine the butter and brown sugar. Beat together on medium-high speed until light and fluffy, about 3 minutes. Mix in the eggs one at a time, beating well after each addition and scraping down the sides of the bowl as needed.

Combine the flour, baking powder, baking soda, and salt in a medium bowl. Stir together to blend. Add the dry ingredients to the mixer bowl on low speed, alternating with the milk, beginning and ending with the dry ingredients, mixing each addition just until incorporated. Blend in the vanilla. Fold in the chocolate chips with a spatula.

Divide the batter evenly between the prepared cupcake liners. Bake for 18-20 minutes, until a toothpick inserted in the center comes out clean. Allow to cool in the pan 5-10 minutes, then transfer to a wire rack to cool completely.

To make the cookie dough filling, combine the butter and sugar in a mixing bowl and cream on medium-high speed until light and fluffy, about 2 minutes. Beat in the flour, sweetened condensed milk and vanilla until incorporated and smooth. Stir in the chocolate chips. Cover with plastic wrap and refrigerate until the mixture has firmed up a bit, about an hour.

To fill the cupcakes, cut a cone-shaped portion out of the center of each cupcake. Fill each hole with a chunk of the chilled cookie dough mixture.

To make the frosting, beat together the butter and brown sugar in the bowl of a stand mixer fitted with the paddle attachment until creamy. Mix in the confectioners’ sugar until smooth. Beat in the flour and salt. Mix in the milk and vanilla extract until smooth and well blended.

Frost the filled cupcakes as desired, sprinkling with mini chocolate chips for decoration.